Substance use: buprenorphine induction: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Substance use: buprenorphine induction

Sample item

A heroin user who took heroin four hours ago is given sublingual buprenorphine and promptly develops severe withdrawal symptoms. This occurs because buprenorphine

AIs a kappa-only agonistBIs a pure antagonist like naloxoneCIs a high-affinity partial agonist that displaces full agonists from the mu receptorDInhibits metabolism of heroin

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Is a high-affinity partial agonist that displaces full agonists from the mu receptor

Buprenorphine binds mu receptors with high affinity but low intrinsic activity, so it displaces full agonists and may precipitate withdrawal if given too early. Induction should wait until mild to moderate withdrawal is present. The same property gives it a ceiling effect on respiratory depression.

Option by option

A. Is a kappa-only agonist
Its main action is at the mu receptor and not exclusive kappa agonism.
B. Is a pure antagonist like naloxone
Buprenorphine is not a pure antagonist, though naloxone is.
C. Is a high-affinity partial agonist that displaces full agonists from the mu receptor (correct)
Correct. A high-affinity partial agonist displaces heroin and precipitates withdrawal.
D. Inhibits metabolism of heroin
It does not inhibit heroin metabolism.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is C, Is a high-affinity partial agonist that displaces full agonists from the mu receptor. Buprenorphine binds mu receptors with high affinity but low intrinsic activity, so it displaces full agonists and may precipitate withdrawal if given too early.

Why is "Is a kappa-only agonist" not the answer?

Its main action is at the mu receptor and not exclusive kappa agonism.

Why is "Is a pure antagonist like naloxone" not the answer?

Buprenorphine is not a pure antagonist, though naloxone is.

Why is "Inhibits metabolism of heroin" not the answer?

It does not inhibit heroin metabolism.

What concept does this question test?

It tests Substance use: buprenorphine induction in Psychiatry. Induction should wait until mild to moderate withdrawal is present. The same property gives it a ceiling effect on respiratory depression.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Substance use: buprenorphine induction?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.